Hormone replacement therapy was commonly used to treat menopausal symptoms in women until a multiyear study by the Women's Health Initiative, which began in 2002, unearthed some concerns. The risks of using long-term hormonal replacement therapy include breast cancer, pancreatitis, gallstones, blood clots and stroke.
With the onset of menopause, the ovaries start to reduce their production of estrogen and progesterone. This decline in hormones halts menstruation and a woman's ability to have a child. It can cause problems such as hot flashes, mood swings, sexual dysfunction, depression and osteoporosis. For many years, doctors used hormone replacement therapy to supplement the declining levels of estrogen.
Clinical Trials
The Women's Health Initiative conducted a clinical trial starting in 2002 that found hormone therapy often posed more health risks than benefits for women. Concerned about these risks, doctors became less likely to prescribe long-term hormone replacement therapy. In addition, about two-thirds of women on hormone therapy discontinued its use, sometimes without consulting their doctors.
Effects
Estrogen, which is commonly used in hormone replacement therapy, has many benefits. It is still one of the most effective treatments for relief of typical menopausal symptoms such as hot flashes, night sweats and vaginal issues, including dryness, itching and burning.
According to the Kronos Early Estrogen Prevention Study, estrogen can reduce the risk of heart disease if taken during the earliest postmenopausal years.
Risks
One risk associated with long-term hormone replacement therapy is an increased incidence of breast cancer. Once the use of estrogen is discontinued, however, the risk diminishes. The risk of breast cancer with typical hormone replacement therapy that combines estrogen with synthetic progesterone is very low, 20 cases more than the expected 1,250 per 10,000 women during a five-year period.
Women who have high triglyceride levels are at an increased risk for pancreatitis if they take oral estrogen with or without progesterone. All women have an increased risk of gallstones if they take hormone replacement therapy.
Blood Clots and Stroke
Estrogen doubles the risk of blood clots and strokes in women and increases the risk of a pulmonary embolism. This risk is highest during the first year of use, especially in women with a history of blood clots. There is also a risk of stroke for women taking estrogen, especially those who smoke and are older than 60.
The Women's Health Initiative substantiated these concerns and determined that women who took a combination of estrogen and progesterone had an increased risk of developing some of these serious conditions.
Estrogen alone
Women who take only Premarin, which is estrogen, experience no increased risk of breast cancer, according to the Women's Health Initiative. However, in one year's time, scientists found that 10,000 women who took estrogen might have 12 more incidents of stroke and six more incidents of blood clots in the legs than women who took a placebo. They also found an increase in mammogram abnormalities.
minimize the risk
Talk with your doctor about ways to reduce the risks involved with long-term hormone replacement therapy. The Women's Health Initiative suggests several ways to do this:
Take it before age 60. The risk that hormone therapy will increase heart problems is not significant. Estrogen may protect the heart if taken during the early menopausal years.
Use the lowest dose for the shortest period of time to reduce symptoms. Likewise, don't stop therapy if you have very debilitating symptoms of menopause.
